Management | Health and Prostate

Archive for the ‘Management’ Category

Management of Complications of Therapy

Posted by admin on June 21st, 2011 No Comments

Management of Complications of Therapy: Erectile Dysfunction Erectile dysfunction is the inability to attain or maintain penile erection sufficient for vaginal intromission. In determining the true incidence of erectile dysfunction as a consequence of prostate cancer therapy, one must consider the total prevalence of erectile dysfunction in the age-matched population. Estimates of all degrees of severity of erectile dysfunction range from 40% in men 40 years of age to 70% in men in their seventies, and are associated with vascular risk factors such as cardiovascular and peripheral vascular disease, hypertension, diabetes, and cigarette smoking. One of the difficulties in isolating the incidence of erectile dysfunction due solely to the complications of prostate cancer therapy, therefore, is the increased incidence of erectile dysfunction associated with aging or concomitant vascular disease. Further, the distinctions between the ability to attain and maintain an erection sufficient for penetration and the patient's observations that "my erection is not as hard as it used to be" complicate assessment Read more [...]

Posted in Management

Erectile Dysfunction following Radical Prostatectomy

Posted by admin on June 21st, 2011 No Comments

Incidence Erectile dysfunction following radical prostatectomy is a common problem, with the incidence variously estimated at 43, 84, and 100%. The discussion of pelvic anatomy below is helpful in understanding the potential surgical pitfalls that can lead to erectile dysfunction. Modifications in the surgical approach may decrease the incidence of postoperative erectile dysfunction. Nerve-sparing prostatectomy has led to a decrease in the incidence of Erectile dysfunction to as low as 10% in selected patients. The perineal approach for radical prostatectomy is associated with a significant incidence of erectile dysfunction. Prostatectomy for benign prostatic hyperplasia may also result in erectile dysfunction. Reported rates of erectile dysfunction vary by procedure, with simple perineal prostatectomy at 29%, suprapubic prostatectomy at 13%, and transurethral resection ranging from 5 to 13.3%. Etiology Understanding the causes and prevention of prostatectomy-associated Erectile dysfunction requires a thorough understanding of pelvic anatomy. In 1982, Walsh and Donker studied stillborn male Read more [...]

Posted in Management

Erectile Dysfunction Evaluation and Treatment

Posted by admin on June 21st, 2011 No Comments

The goals of evaluating patients with erectile dysfunction are to determine the medical and psychosexual causes, assess the degree of dysfunction, and determine treatment goals for both patient and partner. Although multifactorial erectile dysfunction is common, the patient with new onset Erectile dysfunction as a consequence of prostatectomy will be discussed here. As with all patients with erectile dysfunction, a complete psychosexual history is critical for evaluation. Focus on duration of dysfunction, level of libido, presence of morning erections, erection quality, and psychologic factors can help direct further work-up and treatment. Comorbid diseases, particularly diabetes mellitus, hypertension, smoking, vascular disease, and psychiatric illness may also contribute to Erectile dysfunction. While less likely in this group, a fair number of men will have underlying psychogenic factors contributing to their erectile dysfunction. Physical examination with attention to testicular size, gynecomastia, and body habitus, as well as a focused neurologic examination, will also aid in identification Read more [...]

Posted in Management

Management of Benign Prostatic Hyperplasia (BPH): Antiandrogens

Posted by admin on February 17th, 2010 No Comments

The alternative pharmacological approach to patients with benign prostatic hyperplasia (BPH) is to inhibit androgens that are responsible for prostatic hyperplasia. Androgen deprivation is well known to induce prostatic shrinkage. Trials with antiandrogens have been attempted for many years; however, their use has been limited by the high incidence of adverse effects such as impotence and loss of libido. The concept of inhibiting dihydrotestosterone (DHT) came from studies involving patients with a deficiency of the 5-alpha reductase enzyme. This autosomal recessive genetic disorder affects males, who at birth have ambiguous genitals but normal male internal testes and structures, and are thus termed pseudohermaphrodites. These patients were raised as females, but at puberty, with the associated surge of testosterone, their penises enlarged and voices deepened. These males had small prostate glands and never developed benign prostatic hyperplasia (BPH). Finasteride is a potent inhibitor of 5-alpha reductase, decreasing DHT levels by 70%–75%. Since prostatic hyperplasia is contingent on the Read more [...]

Posted in Management

Management of Benign Prostatic Hyperplasia (BPH): Pharmacotherapy

Posted by admin on February 14th, 2010 No Comments

Pharmacologic agents designed to relax prostatic smooth muscle (alpha-adrenergic blockers) and reduce prostatic size (androgen suppression) have been reported to be safe and effective in treating benign prostatic hyperplasia (BPH). The selective alpha-1 blockers doxazosin and terazosin, and the 5-alpha reductase inhibitor finasteride, have been approved by the FDA for the treatment of BPH. Patients with clinically significant BPH are candidates for pharmacotherapy unless they are experiencing severe symptomatology (e.g., serious urinary retention). These agents are reported to improve symptoms of benign prostatic hyperplasia (BPH) with minimal morbidity at a substantial cost savings relative to TURP. Pharmacotherapy: Alpha-Adrenergic Blockers Alpha-1 adrenergic blockers prazosin (Minipress), terazosin (Hytrin) and doxazosin (Cardura) have all been extensively studied in patients with benign prostatic hyperplasia (BPH). These agents relax smooth muscle at the bladder neck and prostatic urethra, offering symptomatic improvement in a relatively short period of time. Although prazosin has demonstrated Read more [...]

Posted in Management

Management of Benign Prostatic Hyperplasia (BPH): Treatment

Posted by admin on February 11th, 2010 No Comments

Treatment for benign prostatic hyperplasia (BPH) must be patient specific and includes watchful waiting and monitoring, pharmacotherapy, minimally invasive therapy and surgery. Certain patients may benefit more from surgery than pharmacotherapy based upon results of the clinician’s evaluation and the patient’s subjective assessment of their disease state. When contemplating therapeutic options, it is important for the clinician to realize that 30%–50% of men will experience spontaneous improvement of symptoms. This is also evident when assessing efficacy in clinical trials since there is a significant placebo effect. Additionally, one must be wary of clinical trials evaluating nonsurgical and minimally invasive therapies for BPH since they often have numerous limitations — they may not be properly randomized, double-blinded or placebo controlled. These inconsistencies might explain why a clear consensus in the literature regarding the effectiveness of different treatment options for benign prostatic hyperplasia (BPH) is lacking. For many years transurethral resection of the prostate (TURP) Read more [...]

Posted in Management

Management of Benign Prostatic Hyperplasia (BPH): Diagnosis

Posted by admin on February 8th, 2010 No Comments

The patient’s initial evaluation should consist of a complete history, physical examination (including digital rectal examination (DRE)), urinalysis and assessment of his renal function (serum creatinine and blood urea nitrogen level). In addition, a urine culture is recommended in order to aid in ruling out a urinary tract infection. All medications the patient is currently taking should be scrutinized since drugs such as anticholinergics (e.g., disopyramide, tricyclic antidepressants, neuroleptics), alpha-adrenergic agonists and calcium channel blockers can cause obstructive symptoms as well. Prostatic enlargement can be identified by DRE (although not very reliably), as well as the more reliable ultrasound and other imaging studies. However, there is little correlation between prostate size and degree of voiding symptomatology. A prostate gland that feels small on palpation may cause a significant degree of bladder outlet obstruction if the area around the urethra, which cannot be palpated, is enlarged. Conversely, an enlarged prostate gland may produce no symptoms if it does not constrict Read more [...]

Posted in Management

Management of Benign Prostatic Hyperplasia (BPH): Clinical Presentation

Posted by admin on February 5th, 2010 No Comments

Patients with benign prostatic hyperplasia experience symptoms of prostatism which are considered either irritative or obstructive in nature (Table 1). The symptomatology of benign prostatic hyperplasia (BPH) often varies, and significant intra- and interindividual variation in symptoms exists. Nocturia, urinary urgency and frequency and pain or burning on urination are typical irritative symptoms, while obstructive symptoms manifest with urinary hesitancy, straining or dribbling during micturition, and a weak or interrupted stream of urine. Initially, the bladder can expel urine past the prostatic blockage. Eventually the bladder is no longer able to compensate, which results in incomplete emptying and stasis of urine within the bladder. Patients may present with severe symptoms that are hallmarks of advanced disease, such as urinary retention, urinary tract infections, nephrolithiasis, hydronephrosis, gross hematuria and compromised renal function. Table 1 Urinary Symptoms of Benign Prostatic Hyperplasia Irritative Symptoms Obstructive Symptoms Dysuria Hesitancy Nocturia Straining Urgency Dribbling Frequency Weak Read more [...]

Posted in Management

Management of Benign Prostatic Hyperplasia (BPH): Pathogenesis

Posted by admin on February 2nd, 2010 No Comments

Benign prostatic hyperplasia (BPH) is the most common cause of voiding dysfunction, and one of the most frequent causes of disability in aging men. BPH is a nonmalignant neoplasm of prostatic epithelial and stromal tissue. Often inappropriately termed "benign prostatic hypertrophy," the disease process involves hyperplasia rather than hypertrophy. Benign prostatic hyperplasia is a rare occurrence in men less than 40 years of age. After age 40 the prevalence of BPH is age-dependent and approximately 50% of men greater than 50 years of age have moderate urinary difficulties due to the disease process. By age 85, approximately 90% of men will have BPH. Men of all races and cultures are afflicted, suggesting the etiology of BPH may not be environmentally or genetically influenced. Often benign prostatic hyperplasia (BPH) is present prior to the fifth decade of life; however, it is benign and unnoticed since patients are usually asymptomatic. Generally BPH becomes symptomatic commencing with the fifth decade of life. Identified risk factors for BPH are aging and normal testicular function. Since the Read more [...]

Posted in Management

Archive for the ‘Management’ Category

Symptoms and Treatment

Drugs. Meds